A scoping review of scores or grading systems for Pelvic venous disorders (PeVD)

Abstract

Background: Pelvic Venous Disorders (PeVD) encompass many conditions linked to chronic pelvic pain (CPP) in women. However, PeVD remain underdiagnosed due to the absence of universally accepted diagnostic criteria. The complexity of PeVD classification across specialties leads to delays in treatment. This scoping review aims to fill a gap in PeVD diagnosis and management by identifying all existing scoring or grading systems, to lay the foundation for standardised clinical scoring tools for PeVD.

Methods: This scoping review was undertaken according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping reviews (PRISMA-ScR). Online databases were searched up to April 2023. Studies implementing a scoring or grading system for patients with confirmed or suspected PeVD were included. Scores or grading systems were classified into four main categories based on their use in the study: screening; diagnosis; measure of disease severity; and measure of response to treatment.

Results: Of the 2976 unique records identified, 82 publications were reviewed in full and 20 were included in this study. Publication dates ranged from 1984 to 2023 (median 2018; IQR: 2003 - 2022). A total of 21 scores/grading systems were identified. Of these, 47.6% (10/21) were clinical scores, and 47.6% (10/21) were scores based on radiological findings; one study included a score that utilised both clinical and radiological findings. The identified scores were used in various settings: 9.52% (2/21) scores used for screening in a tertiary care setting; 14.3% (3/21) used to establish PeVD diagnosis; 38.1% (8/21) used to assess disease severity; and 38.1% (8/21) were used as measures of response to treatment. Of the eight scores assessing disease severity, 50.0% (4/8) assessed the degree of dilatation of pelvic veins and 50% (4/8) assessed the severity of reflux. Only three of the scores were validated.

Conclusion: This scoping review identified a range of scoring and grading systems for PeVD. We note a lack of a validated scoring system both clinical and radiological, for screening and assessment of disease severity. This is an important first step in developing validated disease-specific scoring systems for patient screening, appropriate referral, the assessment of symptom severity, and response to treatment.

Keywords: Pelvic Venous disease; pelvic venous insufficiency; scoping review; score; severity grading.